Disparities in obstetric hemorrhage outcomes.

Both the maternal and fetal outcomes of pregnancy vary greatly according to a pregnant woman's community and her condition. The most devastating outcome is the death of a mother. In 2017, there were ≈295,000 maternal deaths globally with dramatic differences in maternal mortality based on geographic region, country, and women's underlying conditions. Worldwide, the leading cause of maternal death is hemorrhage, comprising 94% of maternal deaths, with most cases occurring in low- or middle-income countries. Whether a hemorrhage originates from inside the uterus (80%-90%), from lacerations or incisions (10%-20%), or from an underlying coagulopathy (<1%), an acute acquired coagulopathy will evolve unless the hemorrhage is controlled. In low- or middle-income countries, the full range of resources to control hemorrhage is not available, but besides the usual obstetric measures, blood availability, hemostatic medication, and hematologic expertise are necessary to save mothers' lives. Hemostasis and thrombosis experts can address the disparities in obstetric hemorrhage outcomes not only as providers but as consultants, researchers, and advocates.

Duke Scholars

Author Andra Hohler James Obstetrics and Gynecology, Maternal Fetal Medicine

Author Jerome Jeffrey Federspiel Obstetrics and Gynecology, Maternal Fetal Medicine